Basic Information
| Provider Information | |||||||||
| NPI: | 1093940074 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GARRETT | ||||||||
| FirstName: | JUSTIN | ||||||||
| MiddleName: | PAUL | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2199 W IRONWOOD CENTER DR | ||||||||
| Address2: | |||||||||
| City: | COEUR D ALENE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838142639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2086254888 | ||||||||
| FaxNumber: | 2086255734 | ||||||||
| Practice Location | |||||||||
| Address1: | 2199 W IRONWOOD CENTER DR | ||||||||
| Address2: | |||||||||
| City: | COEUR D ALENE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838142639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2086254888 | ||||||||
| FaxNumber: | 2086255734 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2009 | ||||||||
| LastUpdateDate: | 07/11/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | O0792 | ID | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.